What it meant: health care in the State of the Union

In last night's State of the Union address, President Barack Obama mentioned health care five times (by my count). One, later in the address, referred to making sure military veterans get the mental health care they need. The other mentions had to do with Medicare: as the nation ages, it's the biggest contributor to our nation's deficit.

Here's what he said:

Already, the Affordable Care Act is helping to slow the growth of health care costs. (Applause.) And the reforms I’m proposing go even further. We’ll reduce taxpayer subsidies to prescription drug companies and ask more from the wealthiest seniors. (Applause.) We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital; they should be based on the quality of care that our seniors receive. (Applause.) And I am open to additional reforms from both parties, so long as they don’t violate the guarantee of a secure retirement. Our government shouldn’t make promises we cannot keep -- but we must keep the promises we’ve already made.

So, has the Affordable Care Act already helped to slow the growth of health care costs - in Rhode Island or nationwide? Yes and no.

In Rhode Island and elsewhere, the Affordable Care Act has meant lower prescription drug costs for seniors. The Act gradually closes the "donut hole," the gap in coverage Medicare subscribers reach at a certain point when they have to pay more out of pocket. It's also meant that more preventative services are covered, like so-called "wellness" check-ups for seniors. The Act has sent more federal dollars to Rhode Island to support community health centers and the start-up of the online health insurance marketplace (or "exchange") that's scheduled to go live in October.

But have those things slowed the cost of health care? Not necessarily. My sources tell me that the kinds of reforms that should lead to lower health care costs overall will take time to show results.

But have those things slowed the cost of health care? Not necessarily. My sources tell me that the kinds ofreforms that should lead to lower health care costs overall will take time to show results. Those reforms include efforts to prevent people from getting sick enough to need to go to the hospital (including better preventative care, more follow up) and paying health care providers to keep a population healthy, rather than paying them for each service they provide--removing the incentive to perform unnecessary tests. Efforts like those are underway in Rhode Island - patient-centered medical homes, accountable care organizations, a movement to improve primary care called the CSI initiative. But again, they take time to show results.

Obama's Medicare prescription was light on details. But as those emerge, Rhode Islanders should pay close attention. As the state with the highest percentage of people over the age of 85 and a growing number of senior citizens, what happens with Medicare will impact us close to home.